Excludes1 pair
J03- vs J36
J03 and J36 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
The official note, declared on J03
peritonsillar abscess (J36)
J36
Peritonsillar abscess
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J30-J39
Use when the record says
- abscess of tonsil
- peritonsillar cellulitis
- quinsy
Indexed under
- Peritonsillitis
- Quinsy (gangrenous)
- Abscess › circumtonsillar
- Abscess › intratonsillar
- Abscess › peritonsillar
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027